What is Perineal Hernia?
While vets and researchers aren’t sure what causes this condition to develop, they do believe that several causes may work together to cause the diaphragm to break or weaken. Perineal hernias are most often seen, diagnosed and treated in older cats, between seven and nine years of age. These cats are also more likely to not to have been altered. Male and female cats can develop perineal hernias.
A perineal hernia is the failure of the cat’s pelvic diaphragm. This hernia can result if the diaphragm simply weakens. This muscle helps to support the structure of the rectum, preventing abdominal organs, including the small intestine, prostate, bladder, rectum, and even fat from crowding into this area. This health issue is easily visible, with an obvious swelling close to the cat’s rectum. The feline will also have other symptoms that show it is obviously ill.
Symptoms of Perineal Hernia in Cats
The cat will be unable to hide signs of illness, especially as the hernia begins to allow abdominal organs to slip into the perineum (the area around the cat’s anus)
- Inability to urinate, retaining urine
- Acute illness because cat is unable to empty bladder completely
- Straining to defecate and urinate
- Urinary incontinence (has “accidents” before reaching its litter box)
- Abdominal pain
- Not interested in food, doesn’t eat
- Changes how it positions its tail
- An obvious lumpy swelling on one or both sides of the cat’s anus
- Bruising in the perineum
- Pain or discomfort
- Vomiting (this happens most often if the blood supply to the bowel is affected)
Causes of Perineal Hernia in Cats
While the causes of perineal hernia aren’t well understood or known, vets suspect that, if the cat hasn’t been neutered or spayed, it may be more vulnerable to developing a hernia. Other causes may include:
- Age (most cats affected are either middle-aged or senior/geriatric
- Prostate enlargement (related to being unaltered)
- Hormone imbalances (disease may affect the cat’s hormone levels)
- Anatomic issues
- Straining to defecate due to disease in this part of the cat’s body
- Straining to urinate because of prostate enlargement
- Damaged nerves in the cat’s pelvic diaphragm
- Testicular disease in male cats
- Disease of the prostate (tumors, abscesses or cysts)
- Increased abdominal pressure resulting from pregnancy
Diagnosis of Perineal Hernia in Cats
Cats with swelling in their perineums should be seen immediately. They will undergo a full physical exam, with the vet’s focus on the cat’s rectum and perineum. The cat will undergo a digital rectal exam, which allows the vet to look for any masses, signs of prostate disease, whether the problem is unilateral (on one side of the cat’s body) or bilateral. The vet also tries to find out the contents of the hernia, or what abdominal organs are intruding into the perineum.
After diagnosing a perineal hernia, the vet orders blood work, including a biochemical profile and a urinalysis, which allows them to determine if the cat has developed a urinary tract infection. An ultrasound and abdominal X-ray help the vet to determine where the cat’s organs are now sitting since the hernia has displaced them. These tests also help the vet to diagnose any other illnesses the cat may have, such as tumors, cancer, and prostate disease. The vet will also be able to see whether any organs have become trapped in the hernia. If so, immediate treatment is needed. If organ entrapment isn’t corrected, this threatens the cat’s life.
While the vet is examining the cat, they will examine the cat’s prostate and testicles (for a male cat) and take a small portion of the prostate for a biopsy. The cat may also undergo a chest X-ray.
Treatment of Perineal Hernia in Cats
Before the cat undergoes surgery, the vet orders medical treatments that include stool softeners, enema, dietary changes or management, painkillers and IV fluid therapy. All of these help to stabilize the cat’s condition if its hernia isn’t life-threatening. These treatments won’t correct or control the hernia.
Surgical intervention is required to correct the hernia and repair the cat’s pelvic diaphragm. While the cat is under anesthesia, the surgeon may also suture or tack the cat’s bladder and colon to the abdominal wall so they won’t protrude into the perineum in the future. The cat’s ductus deferens will also be tacked to the abdominal wall so the prostate won’t herniate in the future. (The ductus deferens is a narrow cord that leads to one of the cat’s testicles.)
The surgeon also places an internal obturator muscle flap, which strengthens the repair work done. This muscle is moved from the floor of the pelvis to the area where the diaphragm failed. If the hernia was severe, the vet may incorporate surgical mesh. If the cat has already been through a hernia repair that failed, the vet may take a flap of muscle from one of the animal’s rear legs to close off the area of the defect/failure to make a second repair. If the cat is an unaltered male, he will be castrated during the hernia repair surgery so the hernia is less likely to return. After castration, the cat’s prostate begins to shrink.
Recovery of Perineal Hernia in Cats
Once a perineal hernia in a cat has been diagnosed, with the appropriate treatments given, the cat can recover and return to full health. Post-surgery, the cat will take pain medications and broad-spectrum antibiotics (antibiotics that are suitable for a broad range of infections) to reduce the chance of infection. Cold compresses placed on the area where surgery took place help reduce perineal irritation and swelling.
Once the cat has recovered from surgery, its diet will change. Its new diet will be a high-fiber diet which, along with stool softeners, to allow it to defecate without straining. This high-fiber food also lessens the risk of a post-surgery breakdown of the repaired diaphragmatic tissue.
The cat should be kept quiet for about two weeks after surgery. Cage rest will help with this. It will also be necessary for the cat to wear an E-collar (Elizabethan collar) so it can’t lick at or bite its stitches.
The cat’s prognosis post-surgery is good as long as it receives all treatments the vet ordered. Hernias may re-develop in about ten to fifteen percent of animals. The vet may prescribe stool softeners long-term to reduce the need for the cat to strain during defecation.
Perineal Hernia Questions and Advice from Veterinary Professionals
Cupcake, a beautiful Flame Point Simease was my 1st foster kitty. He came to me extremely emaciated. He was between 2-3 years old weighing 4 lbs, his beautiful fur was covered in dried mud and fleas. He also had a prolapsed rectum which the shelter had stitched. The day after he arrived at my house he tried to crash and burn with a very severe asthma attack in which he quit breathing 3 times. I took him to the vet that Monday and told to vet he cannot pee, he just dribbles and they said at that time his bladder felt full and prescribed antibiotics. This cat was at the vet at least twice a week and everytime I stressed to them that he could not pee and was just given more antibiotics. Over the next 2 weeks he had 2 more rectal prolapses. On the 3rd prolapse I finally told the ER vet look there is a reason this continues to happen and insisted they do an ultrasound. The ultrasound showed bi-lateral perineal hernias with the bladder and ureters were caught in the hernia. The 1st challenge was to get urine return with the catheter which the vet miraculously accomplished. With the poor health the cat was already in it was suggested by more than 1 vet that he be put to sleep because there was little chance Cupcake could make it through surgery not to mention vets in my area had not done this surgery on a cat. As I am bawling I am telling the vet but Cupcake wants to live. My vet finally agrees to do the surgery but only gave him a 5% chance of survival. He told me he has never seen a bladder this inflamed and angry. Cupcake made it through the surgery but survival chances were still very low and they would remain low I until the catheter was removed to see if he could urinate on his own. Cupcake remained at the vet for the next month. Finally the day came to remove the catheter. The next morning I get a call saying Cupcake urinated a little overnight but not enough to be encouraging. Well Cupcake took offense to that and when the vet picked him up to exam him, Cupcake peed all over the vet. The vet said he was never so happy to be peed on. It was still a few weeks before his bladder got back down to a normal size and he got to come home. The excitement was short lived. A week after Cupcake came home our worst nightmare came true, Cupcake quit urinating and began dribbling again. I call the vet who is on speed dial by this point. Cupcake ended up needing another major surgery, a Urethrostomy in which his entire Penis had to be removed and the ureters brought down to create a new opening to urinate through. The vet was about to give very low odds of survival again but instead said well if anyone can survive it Cupcake can. The vet then kind of sheepishly said what I have said all along, the vet said Cupcake does not act like a cat. He acts like a person and I just said I know, right. That was 3 1/2 years ago and Cupcake now weighs 17lbs and is the biggest foster fail ever. We stay on high alert for UTIs to catch them before they can even start good. Cupcakes is if you touch his flank and he growls. When this happens I have antibiotics in hand within 30 minutes. He has only had 3 UTIs and if I am gone more than 1 night Cupcake comes with me because I trust nobody to watch for that very early sign of a UTI. FYI: Cupcake still has no idea he is a cat.
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My cat has a small hernia, she constantly wee’s where she is not supposed to. We have put extra litter trays around the house where she has been known to wee as she is a house cat but she always finds another spot. She has ruined wooden floors and carpets all over the house. We have caught her a few times looking for places to wee, an when shouted at she will run straight to the litter tray as she knows she is doing wrong. We currently have 5 litter trays down around the house 1 which she uses for number 2’s and the other 4 for number 1’s. she drinks a lot of water we have to refill her bowl a few times a day but she has been like this since a kitten.
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